Learning to be patient: This GP had to switch roles after his cancer diagnosis

It struck suddenly.
 
As he paddled across a wide Gold Coast creek towards his favourite surf spot, Dr Sean Mitchell was suddenly overcome by a wave of total fatigue.
 
It felt like nothing the 35-year-old keen surfer had experienced before.
 
‘I thought, “I just have to get to shore and get out of here”. That was the first sign that something was seriously wrong,’ he told newsGP.  
 
That was last July, as Dr Mitchell juggled full-time work with studying for RACGP Fellowship. After the fatigue passed, he returned to study.
 
By September, he began to feel worse, with symptoms that felt like irritable bowel syndrome (IBS). But that was put down to stress levels as he juggled work and study, alongside a ‘crappy diet’.
 
With the end of his training journey so close, Dr Mitchell could not allow himself to stop.
 
‘I put off getting tested for six to eight weeks. I had symptoms, but I was being stupid – treating myself for something else,’ he said.
 
‘I thought I knew what it was.’
 
It had to be IBS. Surely he had to be too young for the alternative, he told himself.
 
After finishing his final exam in mid-November, Dr Mitchell went for a colonoscopy, concerned that he had a bowel obstruction.  
 
The results were not what he wanted.
 
It was cancer, caught late. Stage four bowel cancer, with metastases in the liver and lymph nodes. Treatment began almost immediately, beginning with life-saving surgery to fix his bowel obstruction.
 
But that surgery did not go smoothly.
 
‘I had a fairly rocky surgical experience, as the procedure was complicated. I realised then that there was no telling what would happen to me,’ Dr Mitchell said.
 
‘You can read all the literature, but I’m an N=1 study. There’s no benefit.
 
‘Initially my prognosis was quite poor – like a 14% survival rate. Reading papers about that, it’s heavy.’  
 
After the difficult surgery, Dr Mitchell disappeared down the rabbit hole of reading about his specific cancer.

Soon, he realised he needed to radically rethink his approach.
 
‘From a self-preservation point of view, I realised I couldn’t do this,’ he said.
 
‘I had to trust my clinicians. I had to switch my mindset.’
 
As the heavy fog from six months of chemo lifts, Dr Mitchell is feeling human again. 
 
He said one of the hardest things about his diagnosis was figuring out how to respond.
 
Was he a doctor? Should he apply his clinical skills to the problem?
 
Or should he be a patient first?
 
‘Being a doctor and a patient is really challenging. It’s one of the hardest things,’ he said. ‘You don’t know everything, but people assume you know more than you do.
 
‘I have to say, talk to me like I’m a patient, because I don’t know a lot about advanced oncology.’
 
Over time, Dr Mitchell stopped trying to be his own doctor and turned his thoughts instead towards finding ways to be positive.
 
‘Having a future-focused outlook – that has evidence supporting it,’ he said.
 
‘People with a positive future focus do better during chemo. It’s probably related to stress levels – if you’re less stressed, your immune system works better and mops up a lot of the cancer.
 
‘I’ve had to learn that my job is to be the patient. I’ve stopped analysing. It’s important for me to trust my clinicians, trust my team.’
 
But for Dr Mitchell’s wife, Dr Michelle Chen, it has been particularly challenging.
 
‘For Michelle, it’s been a little harder to let go, as she’s a doctor,’ Dr Mitchell said. ‘I’ve been more focused on being a patient, not worrying too much about the fine details. She grills the specialists to work out the details.
 
‘I’m very lucky to have someone who can do that; it’s very hard as a patient.’
 
Dr Chen’s new role as doctor–carer is not easy.
 
‘Carers have the hardest role in cancer. I’ve heard patients say that,’ Dr Mitchell said.
 
‘For me, I’ve got a job as a patient, a set of goals I want to achieve. But she has had to put her life on hold to watch me suffer. It’s not very nice.
 
‘It can be thankless as well. When you’re sick, you don’t notice all the little things being done around you. In my experience, the people who need most support during cancer are the carers. That’s what I’ll take forward – when I get someone who’s chronically unwell, I’ll talk to their partner as well and see how they are doing.’
 
Dr Mitchell’s diagnosis led his wife to change her path from surgical training to general practice.
 
‘Michelle changed her career path so we can spend more time together, as surgical life is not compatible with flexibility,’ he said.
 
The road ahead
Now, there remains the small matter of beating this cancer.
 
‘I’ve been doing chemo cycles, so I’ve basically been sitting on the couch being chemo-ed out,’ Dr Mitchell said.

‘It saps your energy, your willpower. I thought it would be like being crook, but it’s unrelenting. It saved my life, though so I’m not bitter about it. It was just more of a process than I thought it would be.'
 
There are new challenges ahead. The chemo has shrunk the major tumours, making them operable. And Dr Mitchell will soon undergo surgery to remove the cancerous half of his liver and get the original tumour in his bowel.
 
‘I’ve had a really good response to chemo, it’s been much better than I expected. So I’m feeling pretty good,’ he said.
 
‘My machine [his body] has been broken with chemo, so I’ve got to build it back up with more muscle before surgery. But I am feeling comfortable with the process.’
 
Once the chemo is finished, Dr Mitchell is also looking forward to sinking his teeth into a possible research project with Bowel Cancer Australia, exploring patient experiences of seeing their GPs.
 
‘In the end, I got diagnosed very quickly. But some patients spend several years trying to access colonoscopy services when they feel something’s wrong,’ he said.
 
‘They can feel resentment, that if they’d been “believed” they could have had earlier access and a different outcome.’
 
Dr Mitchell’s cancer would have been slowly growing for up to five years, his clinicians believe. That makes him part of a small – but growing – cohort of younger people diagnosed with bowel cancer. 
 
‘One in 11 bowel cancers are diagnosed in those under 50, and our screening only begins at 50. That means we’re missing a bunch of people who get it early – and most of those are like me, with advanced tumours,’ he said.
 
Bowel cancer is the second most deadly cancer in Australia, and rates in people younger than 50 keep growing, by around 3% year on year.
 
‘We don’t know why that is. While tumours in the over-50s are reducing significantly because of our screening, the incidence in young people is actually growing,’ Dr Mitchell said.
 
‘For me, my symptoms were really mild until the end.  
 
‘We can’t test every 35-year-old with IBS symptoms. So how do we pick the needle from the haystack? There’s no good test other than colonoscopy, but that’s procedural and can be expensive.
 
‘What I take from it is that it’s not IBS unless you’ve done a colonoscopy. If I’d had one three years ago, I would have been cured.
 
‘This may in part be about GPs making the referral. A lot have felt that it’s just not common to have bowel cancer under 50. The reality is, it is increasing significantly. ‘
 
Dr Mitchell’s training provider GPTQ has been hugely supportive, managing to get his eight remaining weeks of training waived. He has recently been awarded his Fellowship.
 
‘Without them, it would have been really difficult to achieve. I’m extremely fortunate to have had that support,’ he said.
 
As for the big existential questions, life as a doctor has sorted that out for Dr Mitchell already.
 
‘I’ve done enough time in emergency that I’m agnostic on the “why me?” question. It’s not existential for me,’ he said.
 
‘I know that bad things happen to good people. All those questions have already been answered by my clinical experiences, so that’s helped my mindset as well.
 
‘To be a doctor, to be able to care for patients, I feel like that’s a gift they have given me. It’s given me the capacity not to worry about those [existential] things.
 
‘It just is, so we deal with it.’
 
June is Bowel Cancer Awareness Month.
 
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